Ventilator-Associated Pneumonia: What’s New in 2016?
Prevention and treatment of ventilator-associated pneumonia (VAP) are important issues in critically ill patients. The incidence of VAP is used as an indicator of quality in the United States. Recent studies demonstrated that the incidence of this infection is directly related to the diagnosis method used. The new definition suggested for ventilator-associated complications is not accurate in diagnosing VAP; therefore it is not recommended for routine use. Several diagnosis methods are under investigation such as assessment of lung microbiota, metabolic analysis of exhaled breath, and multiplex polymerase chain reaction performed on bronchoalveolar lavage. A new score based on procalcitonin level and chest echography might also be helpful. Subglottic secretion drainage is an efficient preventive measure for VAP. Continuous control of tracheal cuff pressure is a promising preventive measure, but its efficiency should be confirmed by further studies. The impact of prophylactic inhaled antimicrobials, and systemic antibiotic treatment in patients with ventilator-associated tracheobronchitis on VAP incidence should also be investigated. Recent studies showed no clear benefit of using probiotics, conical-shaped cuff, or polyurethane-cuffed tracheal tubes on VAP incidence. Two recent meta-analyses suggested a beneficial effect of inhaled antimicrobials in treating VAP. However, further well-designed and performed studies are required to confirm these data.